Anti-TPO Antibodies and Their Role in Thyroid and Reproductive Health

If you’re struggling with recurrent pregnancy loss, IVF failure, or hypothyroidism and planning for conception, you’ve likely come across the term anti-TPO antibodies.

As a reproductive immunologist with years of experience in Mumbai, India, I’ve seen how these antibodies can impact fertility and how the right management can turn things around. Let’s break this down in simple, human terms.

Anti-TPO antibodies, also known as thyroid peroxidase antibodies, are proteins produced by your immune system that mistakenly attack an enzyme called thyroid peroxidase. This enzyme is critical for converting thyroglobulin into active thyroid hormones (T3 and T4), which regulate metabolism, energy, and even reproductive health.

Now, this can result in a reduction in the level of T4, which is produced by the thyroid gland. That means the active thyroxine levels in the body can go down, and typically, as a result of this, the feedback loop causes elevated levels of TSH, that is, thyroid-stimulating hormone. Resulting in clinical or subclinical hypothyroidism in the patient. 

Now it is very important for us to understand that the anti-TPO antibody plays a very, very important role in the management of thyroid function. As a result of this, it can negatively affect the reproductive behavior of a female patient. Monitoring of anti-TPO antibodies is extremely important. If you are a patient who has suffered from recurrent pregnancy loss or recurrent IVF failure, or you are a patient with hypothyroidism and planning for fertility. 

The anti-TPO antibody is a basic blood test where the reports would simply turn out to be either positive or negative. Any value of more than 35 international units per mL is considered to be positive in a clinical situation.  

It has been consistently proven without any doubt that anti-TPO antibody and then correction with supplementation of thyroid to maintain a euthyroid status, that is, a value of TSH ideally in between 1.0 and 2.5, is critically important and essential in order to make sure that the reproductive function for a patient is normal. 

Whenever an anti-TPO antibody is positive, as a reproductive immunologist, I would very strongly also recommend testing for the other autoimmune dysfunction. For example, testing the level of ANA titres.

Thyroid supplementation is strongly recommended for the patient who is anti-TPO antibody positive, along with values of TSH > 2.5, and is planning for conception.

It is also recommended in patients who have experienced a previous recurrent pregnancy loss that is more than two episodes of abortions or in patients who have had two previous IVF failures with top-quality embryos, preferably chromosome-normal or euploid embryos.

The standard supplementation, which is implemented in order to make sure that the patient stays Euthyroid, is approximately a 25 to 50 µg dosage, which is administered orally once in the morning.

Now there is a big debate on this question because there is no study guideline that strongly recommends this type of thyroid supplementation at a clinical range between TSH 1.0 and 2.5.

Because the guideline regarding this is very, very unclear in my private practice, I would like to give the patient thyroid supplementation in this situation only if they’ve had more than two previous abortions or more than two previous IVF cycles that failed with top-quality embryos.

If the history for this is not positive, then we would like to avoid giving thyroid supplementation to the patient. However, we would make sure that very strict monitoring is being done for the patient as far as TSH levels are concerned. The TSH level monitoring is done preconception as well as in the first, second, and third trimesters for the patient.

The ideal calculation is done based on the body weight of the patient. However, initial supplementation is begun at 25 to 50 µg as an oral tablet, which is to be administered in the morning prior to having breakfast.

The answer to this question is an absolute and loud YES. In my clinical practice, I have seen a countless number of patients who have experienced an extremely successful pregnancy outcome despite having elevated levels of anti-TPO antibody.

Drugs like aspirin have been found to give no additional clinical benefit in a patient who has thyroid autoantibodies. Drugs like HCQS, or hydroxychloroquine, have also not been proven to give any benefit to patients who are suffering from thyroid autoantibodies. 

But in a real-life, practical, and clinical situation, what I see is that many times patients who are having thyroid autoantibodies may also develop antibodies to other organs, and the majority of them, or at least some of them, will also come with ANA-positive titers, that is, anti-anti-nuclear antibody titers positive.

Drugs like HCQS are predominantly used for the purpose of immune stabilisation, and they need to be administered to the patient in a dose of 200 mg twice a day for at least 2 to 3 months prior to seeing any type of visible effect. We do not use supplementation with HCQS very frequently in clinical practice, unless and until the patient satisfies the above-mentioned criteria.

As a practicing reproductive immunologist in India, I very strongly understand the fact that a lot of patients get immensely stressed out because they end up reading a lot of stuff on social media. As far as thyroid and autoantibodies are concerned, they try to form an interpretation of the disease based on their limited reading of research and understanding.

I strongly encourage all these users to consult a reproductive immunologist who can thoroughly guide you as far as the clinical aspect of your situation is concerned, and this will very strongly help you reduce your unnecessary anxiety as regards to this disease.

Anti-TPO antibodies don’t have to stand in the way of your dream of parenthood. With the right testing, thyroid management, and a reproductive immunologist in your corner, you can move forward with confidence.

If you’re in Mumbai (or anywhere in India) and want to discuss your case, reach out. Let’s turn those “what-its” into “what’s next.”

Dr. Jay Mehta is a leading reproductive immunologist in Mumbai, specializing in thyroid health, recurrent pregnancy loss, and IVF outcomes. For personalized guidance, schedule a consultation today; call us at 1800-268-4000.